A brief descriptions, types, mode of action, pathology, C/F, D/D and management of Viral and Bacterial Conjunctivitis.
- 1.Viral & Bacterial Conjunctivitis Sourov Roy 3rd Batch, B.Optom, ICO,CU
2. Definition Conjunctivitis: inflammation of the conjunctiva Conjunctiva: thin, translucent, elastic tissue layer with bulbar and palpebral portions Bulbar: lines the outer surface of the globe to the limbus (junction of sclera and cornea) Palpebral: covers the inside of the eyelids Two layers: epithelium, substantia propria 3. Eye Anatomy 4. Classification of Conjunctivitis Viral Infectious Hyperacute Bacterial Acute Chronic Noninfectious Allergic, Toxins/ Chemicals, Foreign body, Trauma, Neoplasm 5. Etiological classification 1. Infective conjunctivitis: bacterial, chlamydial, viral,fungal, rickettsial, spiro chaetal, protozoal, parasitic etc. 2. Allergic conjunctivitis. 3. Irritative conjunctivitis. 4. Keratoconjunctivitis associated with diseases of skin and mucous membrane. 5. Traumatic conjunctivitis. 6. Keratoconjunctivitis of unknown etiology. eg: Trachoma.. 6. Prevalence 7. Viral Conjunctivitis Most common viral cause is adenovirus (enterovirus, HSV) Occurs in community epidemics (schools, workplaces, physicians offices) Usual modes of transmission: contaminated fingers, medical instruments, swimming pool water 8. Viral infections of conjunctiva include: Adenovirus conjunctivitis Herpes simplex keratoconjunctivitis Herpes zoster conjunctivitis Pox virus conjunctivitis Myxovirus conjunctivitis Paramyxovirus conjunctivitis ARBOR virus (ARthropod-BOrne virus) conjunctivitis 9. Clinical presentations. Acute viral conjunctivitis may present in three clinical forms: 1. Acute serous conjunctivitis 2. Acute haemorrhagic conjunctivitis 3. Acute follicular conjunctivitis 10. Symptoms: include: unilateral or bilateral redness, watering, mild mucoid discharge, mild photophobia feeling of discomfort and foreign body sensation. 11. May be part of viral prodrome: tender preauricular node adenopathy, fever, pharyngitis, cough, rhinorrhea 12. ACUTE SEROUS CONJUNCTIVITIS Etiology. It is typically caused by a mild grade viral infection which does not give rise to follicular response. 13. Clinical features. Acute serous conjunctivitis is characterised by - a minimal degree of congestion, - watery discharge and - boggy swelling of the conjunctival mucosa. 14. Treatment. Usually it is self-limiting and does not need any treatment. But to avoid secondary bacterial infection, --broad spectrum antibiotic eye drops may be used three times a day for about 7 days. 15. ACUTE HAEMORRHAGIC CONJUNCTIVITIS It is an acute inflammation of conjunctiva characterised by multiple conjunctival haemorrhages, conjunctival hyperaemia and mild follicular hyperplasia. 16. Etiology. The disease is caused by picornaviruses 17. Symptoms: include pain, redness, watering, mild photophobia transient blurring of vision and Lid swelling. 18. Signs: conjunctival congestion, chemosis, multiple haemorrhages in bulbar conjunctiva, mild follicular hyperplasia, lid oedema and pre-auricular lymphadenopathy. 19. Corneal involvement may occur in the form of -fine epithelial keratitis. 20. Treatment very infectious and poses major potential problems of cross-infection. Therefore, prophylactic measures are very important. No specific effective curative treatment is known. However, broad spectrum antibiotic eye drops may be used to prevent secondary bacterial infections. Usually the disease has a self-limiting course of 5-7 days. 21. FOLLICULAR CONJUNCTIVITIS Types 1. Acute follicular conjunctivitis. 2. Chronic follicular conjunctivitis. 3. Specific type of conjunctivitis with follicle formation e.g., trachoma 22. ACUTE FOLLICULAR CONJUNCTIVITIS It is an acute catarrhal conjunctivitis associated with-- marked follicular hyperplasia-- especially of the lower fornix and lower palpebral conjunctiva. 23. Symptoms --- similar to acute catarrhal conjunctivitis include: Burning and grittiness in the eyes, especially in the evening. Feeling of heat and dryness on the lid margins. Difficulty in keeping the eyes open. Feeling of sleepiness and tiredness in the eyes 24. Mild chronic redness in the eyes. Mild mucoid discharge especially in the canthi. Off and on lacrimation. 25. Signs conjunctival hyperaemia, associated with- multiple follicles, more prominent in lower lid than the upper lid 26. Treatment Primary herpetic infection is usually selflimiting. The topical antiviral drugs control the infection effectively and prevent recurrences 27. BACTERIAL CONJUNCTIVITIS Etiology: - Predisposing factors - Causative organisms - Acording to Mode of infection 28. Pathology Vascular response Cellular response Conjunctival tissue repsonse Conjunctival discharge 29. CLINICAL TYPES OF BACTERIAL CONJUNCTIVITIS Acute catarrhal or mucopurulent conjunctivitis. Acute purulent conjunctivitis Acute membranous conjunctivitis Acute pseudomembranous conjunctivitis Chronic bacterial conjunctivitis Chronic angular conjunctivitis 30. ACUTE MUCOPURULENT CONJUNCTIVITIS Common causative bacteria are: Staphylococcus aureus, Koch-Weeks bacillus, Pneumococcus and Streptococcus. 31. Symptoms Discomfort and foreign body Mild photophobia. Mucopurulent discharge from the eyes. Sticking together of lid margins Slight blurring of vision due to mucous flakes may complain of coloured halos. 32. Signs Conjunctival congestion Chemosis Petechial haemorrhages Flakes of mucopus Cilia are usually matted Yellow crust 33. Differentiate Diagnosis CLINICAL SIGNS Bacterial Viral Congestion Marked Moderate Chemosis ++ Subconjunctival haemorrhages Discharge Purulent or mucopurulent Watery Papillae Follicles + Pseudomembrane Pannus Pre-auricular lymph nodes + ++ 34. Complications Occasionally the disease may be complicated by marginal corneal ulcer, superficial keratitis, blepharitis or dacryocystitis 35. Treatment Topical antibiotics- broad specturm antibiotics Irrigation of conjunctival sac Dark goggles No steroids should be applied No bandage Anti-inflammatory and analgesic drugs 36. ACUTE PURULENT CONJUNCTIVITIS Etiology: -causative organism Clinical picture: 1 Stage of infiltraton 2 Stage of blenorrhoea 3 Stage of slow healing 37. Stage of infiltraton Considerably painful and tender eyeball. Bright red velvety chemosed conjunctiva. Lids are tense and swollen. Discharge is watery or sanguinous. Pre-auricular lymph nodes are enlarged. 38. Stage of blenorrhoea Frankly purulent, copious, thick discharge trickling down the cheeks. Other symptoms are increased but tension in the lids is decreased 39. Complications 1. Corneal involvement 2. Iridocyclitis 3. Systemic complications - gonorrhoea arthritis - endocarditis - septicaemia 40. Treatment Systemic therapy: Norfloxacin 1.2 gm orally qid for 5 days Cefoxitim 1.0 gm or cefotaxime 500 mg. IV qid or ceftriaxone 1.0 gm IM qid, all for 5 days; or Spectinomycin 2.0 gm IM for 3 days Topical antibiotic therapy ofloxacin, ciprofloxacin or tobramycin eye drops bacitracin or erythromycin eye ointment 41. Irrigation of the eyes Topical atropine 1 per cent Patient and the sexual partner should be referred for evaluation of other sexually transmitted diseases 42. OPHTHALMIA NEONATORUM Source and mode of infection: - Before birth infection is very rare through infected liquor amnii in mothers with ruptured membrances - During birth. - After birth 43. Causative agents Chemical conjunctivitis Gonococcal infection Other bacterial infections Herpes simplex ophthalmia neonatorum 44. Symptoms and signs 1. Pain and tenderness in the eyeball. 2. Conjunctival discharge. It is purulent in gonococcal ophthalmia neonatorum and mucoid or mucopurulent in other bacterial cases and neonatal inclusion conjunctivitis. 3. Lids are usually swollen. 4. Conjunctiva may show hyperaemia and chemosis 5. Corneal involvement, though rare. 45. Complications may develop corneal ulceration, Which may perforate rapidly resulting in corneal opacification or staphyloma formation. 46. Treatment A. Prophylaxis needs antenatal, natal and postnatal care. Curative treatment: Chemical ophthalmia neonatorum is a self- limiting condition, and does not require any treatment. 47. Topical therapy - Saline lavage -Bacitracin eye ointment 4 times/day However in cases with proved penicillin susceptibility, penicillin drops 5000 to 10000 units per ml should be instilled every minute for half an hour, every five minutes for next half an hour and then half hourly till the infection is controlled. 48. Systemic therapy: Ceftriaxone 75-100 mg/kg/day IV or IM, QID. Cefotaxime 100-150 mg/kg/day IV or IM, 12 hourly. Ciprofloxacin 10-20 mg/kg/day or Norfloxacin 10 mg/kg/day.